Provider Demographics
NPI:1659502185
Name:LILJE, KATHRYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:LILJE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 E FERN AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6057
Mailing Address - Country:US
Mailing Address - Phone:909-908-4360
Mailing Address - Fax:
Practice Address - Street 1:4211 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3502
Practice Address - Country:US
Practice Address - Phone:951-340-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist